Ramu’s SignPersons with a conical neck, especially in the antero lateral area of root

of neck, often feel a vague pain which aggravates by applying local

pressure on the said area, rarely a radiating pain down the ipsilateral

arm may also be elicited. The Brachial plexus in such situations is

subjected to kink over the elevated tissue, soft and bony, caused by

hypertrophic transverse processes of C7 vertebrae or cervical ribs. The

kink leads to a tightness and traction on the spinal nerves, increasing

with advancing age and reduced physical activity. This is demonstrable

in radiographs & MRIs of root of neck. The said pain is not felt in

persons with normal transverse processes of C7 vertebra or in absence of

cervical rib/band.

Presence of prefixed cervical spinal nerves may also give a similar sign.

The point to ponder is, if hypertrophied transverse processes of C7

spine/cervical rib/cervical band happen to coexist with prefixed spinalnerves.

Prominent & hypertrophied Transverse Process of C7 Vertebra

Magnified view

Prominent & hypertrophied Transverse Process of C7 Vertebra

Yet another such situation, much grosser

Note the conical form of neck & dimpled Rt. C7 transverse process

Yet another case

Bilateral Cervical Ribs

X Ray & MRI of neck of a young male with Ramu’s sign. Presented with brachialgia Right side.

EnlargedView ofthe sameMRI

Note kinkIn spinalnerves inthe firsttwo screens

X-Ray ofmy ownNeck

This feature is not a known or traceable entity in literature and I humbly dedicate this phenomenon to

my God Father Dr D Ramu garuas Ramu’s Sign

Dr V S N Rajuemail : intacthands@gmail.com

WADEM 2011 BIEGING, CHINA

ARC Orthopaedic Clinic, ECIL, ARC Road, Hyderabad, INDIA